1	Arthritis and Physical Therapy PT 260
2	Arthritis Over 40 million people (1 in 7) in US have arthritis Incurable disease Accounts for many missed work days and many people out of work on disability
3	Exercise Goals for Arthritis Slow or reverse debilitating effects Loss of flexibility Loss of strength Loss of endurance Directly address impairments, functional limitations, and disabilities Improve overall health status through exercise
4	Types of Arthritis Osteoarthritis Rheumatoid Arthritis Gout Juvenile Rheumatoid Arthritis Lupus Ankylosing Spondylitis Psoriatic Arthritis 120 different forms
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6	Normal Joint
7	Osteoarthritis
8	Rheumatoid Arthritis
9	Rationale for Ther Ex in Osteoarthritis Asymmetrical cartilage loss leads to abnormal forces on the joint Uneven pull on muscles and ligaments leads to muscle and ligamentous imbalance Joint mechanics are altered Adjacent joints and contralateral are often affected: limitations in ROM and strength Increased energy expenditure
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11	Rationale for Ther Ex in RA Pain and effusion trigger protective and reflex spasm and immobility Further muscle atrophy and loss of normal protective responses Immobility has detrimental effects Joint misalignment leads to inefficient movement patterns Muscle atrophy because of abnormal muscle use, effects of low-dose steroids, and myositis
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13	Treatment Goals for OA Decrease inflammation Restore normal joint mobility Reestablish balance between muscle length and strength around the joint Address associated problems in other joints Relate treatment to functional tasks Maintain or improve cardiovascular fitness
14	Treatment Goals for RA Same as for OA, but consider stage of illness In periods of acute flare ups, exercise is decreased, some MDs say rest only Pt education is very important so that pt can recognize symptom development and modify exercise accordingly Energy conservation
15	Pain Thermal modalities Heat Ice TNS Regular exercise should be scheduled for late morning or early afternoon, especially in RA
16	Mobility Impairment Passive ROM in acute exacerbation and severe weakness and inflammation in RA 1 or 2 repetitions through full ROM per day Active ROM in pts with OA or in less active periods of RA Stretching is appropriate if joint is stable Positioning is important for safety and stability Gentle mobilization may be applied to OA patients
17	Strengthening Isometrics in acute flares of OA and RA In RA, brief isometrics (3-6 sec) with 2/3 maximal effort; 20 sec rest Same for acute OA, especially when BP is an issue In subacute stages, low resistance, high reps are recommended; use range that does not irritate the joint Progression may be slow
18	Cardiovascular Endurance Impairment Important part of exercise program Need to be aware of stresses on joints Bicycling, walking, treadmills, Nordic track Aquatic therapy highly recommended
19	Aquatic Therapy Allows performance of movement patterns that may not be possible on land Can relax muscles Can modify pain perception Social interaction
20	Joint Protection Positioning during exercise and ADLs Special precautions for C-spine laxities Splints, orthotics, braces Assistive devices Weight reduction
21	Energy Conservation Schedule tasks to conserve energy Use adaptive equipment and devices to assist Adequate rest Progress exercises slowly Keep resistance low (1-3 lb in UE), increase reps Home modifications may be beneficial Start early; don’t wait for debilitation
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